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Worel N, Holbro A, Vrielink H, Ootjers C, Le Poole K, Beer-Wekking I, Rintala T, Lozano M, Bonig H. A guide to the collection of T-cells by apheresis for ATMP manufacturing-recommendations of the GoCART coalition apheresis working group. Bone Marrow Transplant 2023; 58:742-748. [PMID: 37024570 DOI: 10.1038/s41409-023-01957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
Autologous chimeric antigen receptor-modified T-cells (CAR-T) provide meaningful benefit for otherwise refractory malignancies. As clinical indications for CAR-T cells are expanding, hospitals hitherto not active in the field of immune effector cell therapy will need to build capacity and expertise. The GoCART Coalition seeks to disseminate knowledge and skills to facilitate the introduction of CAR-T cells and to standardize management and documentation of CAR-T cell recipients, in order to optimize outcomes and to be able to benchmark clinical results against other centers. Apheresis generates the starting material for CAR-T cell manufacturing. This guide provides some initial suggestions for patient's apheresis readiness and performance to collect starting material and should thus facilitate the implementation of a CAR-T-starting material apheresis facility. It cannot replace, of course, the extensive training needed to perform qualitative apheresis collections in compliance with national and international regulations and assess their cellular composition and biological safety.
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Affiliation(s)
- Nina Worel
- Department for Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria.
| | - Andreas Holbro
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
- Division of Hematology, University Hospital Basel and University Basel, Basel, Switzerland
- Innovation Focus Cell Therapies, University Hospital Basel, Basel, Switzerland
| | - Hans Vrielink
- Department for Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Claudia Ootjers
- Department of Hematology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kaatje Le Poole
- Department for Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Ingrid Beer-Wekking
- Department of Hematology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Miquel Lozano
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, University Clinic Hospital, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt a.M., Germany
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
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Kondo T, Fujii N, Fujii K, Sumii Y, Urata T, Kimura M, Matsuda M, Ikegawa S, Washio K, Fujiwara H, Asada N, Ennishi D, Nishimori H, Matsuoka KI, Otsuka F, Maeda Y. Low hematocrit reduces the efficiency of CD34 + cell collection when using the Spectra Optia continuous mononuclear cell collection procedure. Transfusion 2022; 62:1065-1072. [PMID: 35322885 DOI: 10.1111/trf.16856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND CD34+ cell collection efficiency (CE) is the determining factor when calculating processed blood volume (PBV) for leukapheresis (LP). However, the factors affecting CE in the continuous mononuclear cell collection (cMNC) protocol performed by the Spectra Optia apheresis system are not well established. STUDY DESIGN AND METHODS We retrospectively collected the data from 147 consecutive apheresis procedures across 106 healthy donors and 27 patients completed between July 2016 and December 2020 at the Okayama University Hospital. All procedures were performed using the Optia cMNC protocol. RESULTS The median CD34+ CE2 was significantly higher in the donor samples (64.3%) than in the patient samples (46.8%) (p < .0001). WBC counts, hematocrit, and platelet counts were all significantly higher in the donors than in the patients, and there was a moderate positive correlation between CD34+ CE2 and hematocrit (r = .47, p < .0001), with the equation of the line being y = 1.23x + 12.23. In contrast, there was only a very weak correlation between CD34+ CE2 and WBC or platelet count. In addition, low hematocrit correlated with an increased time to interface formation. CONCLUSION These data revealed the negative impact of low hematocrit on the efficiency of CD34+ cell collection when using the Optia cMNC protocol and suggest that hematocrit values should also be considered when determining PBV.
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Affiliation(s)
- Takumi Kondo
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Nobuharu Fujii
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Keiko Fujii
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Division of Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Yuichi Sumii
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Urata
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Maiko Kimura
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Masayuki Matsuda
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Shuntaro Ikegawa
- Division of Transfusion, Okayama University Hospital, Okayama, Japan.,Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Kana Washio
- Department of Pediatrics/Pediatric Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan.,Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Fumio Otsuka
- Division of Clinical Laboratory, Okayama University Hospital, Okayama, Japan.,Department of General Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
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Optimizing leukapheresis product yield and purity for blood cell-based gene and immune effector cell therapy. Curr Opin Hematol 2021; 27:415-422. [PMID: 32889828 DOI: 10.1097/moh.0000000000000611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW A critical common step for blood-based ex-vivo gene and immune effector cell (IEC) therapies is the collection of target cells for further processing and manufacturing, often accomplished through a leukapheresis procedure to collect mononuclear cells (MNCs). The purpose of this review is to describe strategies to optimize the apheresis product cell yield and purity for gene and IEC therapies. Relevant data from the conventional bone marrow transplant literature is described where applicable. RECENT FINDINGS Product yield is affected by three main factors: the peripheral blood concentration of the target cell, optimized by mobilizing agents, donor interventions or donor selection; the volume of peripheral blood processed, tailored to the desired product yield using prediction algorithms; and target cell collection efficiency, optimized by a variety of device and donor-specific considerations. Factors affecting product purity include characteristics of the donor, mobilizing agent, device, and device settings. SUMMARY Strategies to optimize product yield and purity for gene and IEC therapies are important to consider because of loss of target cell numbers or function with downstream steps and detrimental effects of nontarget cells on further manufacturing and patient outcome.
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Coffe C, Pouthier F, Barisien C, Slimane M, Sheytanova A. Therapeutic leukapheresis and thrombapheresis in medical emergencies. Transfus Apher Sci 2020; 59:102997. [PMID: 33189569 DOI: 10.1016/j.transci.2020.102997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The management of hyperleukocytosis or thrombocytosis by therapeutic cytapheresis in the early 21 st century is far from codified (universal). Therapeutic cytapheresis have been proposed to achieve more rapid cytoreduction in peripheral blood than old universal support in order to quickly prevent potential complications. But, there are no randomized studies demonstrating the superiority of cytapheresis over other treatments alone. In this short review, based on our own experience (since 1980), we will give the indications and the role of cytapheresis procedures and we will try to answer the questions: when is therapeutic cytapheresis appropriate and do they still have a place in 2020, especially as a medical emergency?
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Affiliation(s)
| | - Fabienne Pouthier
- Department of Cellular and Tissue Engineering, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
| | - Christophe Barisien
- Department of Blood Donations, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
| | - Mohamed Slimane
- Etablissement Français du sang Bourgogne, Franche Comté, Dijon, France
| | - Antoaneta Sheytanova
- Department of Therapeutic Apheresis, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
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Jarisch A, Rettinger E, Sörensen J, Klingebiel T, Schäfer R, Seifried E, Bader P, Bonig H. Unstimulated apheresis for chimeric antigen receptor manufacturing in pediatric/adolescent acute lymphoblastic leukemia patients. J Clin Apher 2020; 35:398-405. [PMID: 32750197 DOI: 10.1002/jca.21812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Autologous unstimulated leukapheresis product serves as starting material for a variety of innovative cell therapy products, including chimeric antigen receptor (CAR)-modified T-cells. Although it may be reasonable to assume feasibility and efficiency of apheresis for CAR-T cell manufacture, several idiosyncrasies of these patients warrant their separate analysis: target cells (mononuclear cells [MNC] and T-cells) are relatively few which may instruct the selection of apheresis technology, low body weight, and, hence, low total blood volume (TBV) can restrict process and product volume, and patients may be in compromised health. We here report outcome data from 46 consecutive leukaphereses in 33 unique pediatric patients performed for the purpose of CD19-CAR-T-cell manufacturing. Apheresis targets of 2×109 MNC/1×109 T-cells were defined by marketing authorization holder specification. Patient weight was 8 to 84 kg; TBV was 0.6 to 5.1 L. Spectra Optia apheresis technology was used. For 23 patients, a single apheresis sufficed to generate enough cells and manufacture CAR-T-cells, the remainder required two aphereses to meet target dose and/or two apheresis series because of production failure. Aphereses were technically feasible and clinically tolerable without serious adverse effects. The median collection efficiencies for MNC and T-cells were 53% and 56%, respectively. In summary, CAR apheresis in pediatric patients, including the very young, is feasible, safe and efficient, but the specified cell dose targets can be challenging in smaller children. Continuous monitoring of apheresis outcomes is advocated in order to maintain quality.
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Affiliation(s)
- Andrea Jarisch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Jan Sörensen
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Richard Schäfer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany.,Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, USA
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